Application value of ileal D-pouch in the total proctocolectomy with ileal pouch-anal anastomosis

Abstract

Objective To explore the clinical value of ileal D-pouch in the total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA). Methods The retrospective cross-sectional study was conducted. The clinical data of 9 patients with ulcerative colitis and 8 patients with familial polyposis who underwent TPC-IPAA at the Zhongnan Hospital of Wuhan University between October 2014 and June 2015 were collected. The ileal D-pouch was built during the operation. Observation indicators: (1) intra- and post-operative situations: surgical situation, intraoperative complications, interval time between TPC-IPAA and ileostomy, total operation time, build time and volume of ileal D-pouch, volume of intraoperative blood loss, recovery time of postoperative gastrointestinal function, time of postoperative drainage-tube removal, postoperative complications and duration of hospital stay, (2) follow-up situation. Follow-up was performed by outpatient examination and telephone interview up to July 2016. Follow-up included detecting the patients′ recovery and evaluating gastrointestinal quality of life index (GIQLI), postoperative Wexner incontinence score, frequency of defecation at 24 hours and at the night and patients′ satisfaction. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were represented as the M (range). Results (1) Intra- and post-operative situations: 17 patients underwent TPC-IPAA, and no patient died during the perioperative period. One patient with familial polyposis had intraoperative intestinal perforation, and handsewn TPC-IPAA was conducted after building ileal D-pouch. And other patients didn′t have postoperative complications. Of 9 patients with ulcerative colitis, 1 underwent three-stage operation and other 8 underwent two-stage operations. Nine patients underwent ileostomy at (177±38)days after TPC-IPAA. Of 8 patients with familial polyposis, 1 underwent one-stage operation and other 7 underwent two-stage operations. Seven patients underwent ileostomy at (158±45)days after TPC-IPAA. Total operation time, build time of ileal D-pouch, volume of ileal D-pouch, volume of intraoperative blood loss, recovery time of postoperative gastrointestinal function and time of postoperative drainage-tube removal in the 17 patients were (216±25)minutes, (18±4)minutes, (172±18)mL, (107±31)mL, (43±10)hours and (7.9±2.1)days, respectively. Three patients complicated with wound infection or fat liquefaction were improved by symptomatic treatment. One patient with ulcerative colitis was complicated with incomplete intestinal obstruction at 5 days postoperatively and then improved by symptomatic treatment. Other patients didn′t have postoperative complications. A median duration of postoperative hospital stay in the 17 patients was 9 days (range, 7-17 days). (2) Follow-up situation. All the 17 patients were followed up for 12-21 months with a median time of 16 months. During the follow-up, 1 patient was complicated with vaginal fistula at 21 days postoperatively and then was cured at 26 days after conservative treatment. All the 17 patients didn′t have fecal incontinence at night. One patient continued to take oral antidiarrheal-drugs for 7 months, and dietary restrictions of 2 patients were respectively relieved at 2 months and 8 months postoperatively. GIQLI, postoperative Wexner incontinence score, frequency of defecation at 24 hours and at the night were 113±12, 3.3±0.8, 5.5±1.2, 2.0±0.6 at 1 month postoperatively and 120±9, 2.8±0.8, 5.0±1.0, 1.5±0.5 at 3 months postoperatively and 122±7, 2.7±0.6, 4.6±0.8, 1.0±0.6 at 6 months postoperatively and 122±7, 2.5±0.6, 4.3±1.0, 0.8±0.6 at 12 months postoperatively, respectively. Sixteen patients were very satisfied with surgical outcomes and 1 was partially satisfied with surgical outcomes. Conclusion Ileal D-pouch is safe and feasible in the TPC-IPAA of patients with ulcerative colitis and familial polyposis, with the advantages of postoperative good anus functions and high quality of life. Key words: Ulcerative colitis; Familial polyposis; Total proctocolectomy with ileal pouch-anal anastomosis; Ileal D-pouch